Subdural Hematoma Intracranial Adults

General Information Subdural hemorrhage is bleeding below the dural membrane, whereas epidural hemorrhage, as previously discussed, is bleeding above the dura, i.e. between the dura and the overlying calvarium or base of the skull. The most common cause of a subdural hematoma is some form of direct impact trauma either as the result of an assault, fall or vehicular accident. Acute subdural hemorrhages can also result from sudden acceleration-deceleration of the head in which there is no injury to the head as would be the case in a whiplash-like injury such as occurs with a rear-end collision by a motor vehicle, blast injury or violent shaking during torture as reported by Pounder et al in 1997. Although some forensic pathologists do not believe there is such an entity or 'spontaneous subdural hemorrhage,' others disagree. Leestma clearly states that 'spontaneous subdural hemorrhage' does occur, doing so primarily in infancy due to abnormalities of coagulation, either inherited (inherited platelet disorders) or acquired; during delivery; some inherited errors of metabolism (mitochondrial disorders such as Alpers disease and Menke disease and glutaric acidemia type 1 (GA-I); vascular anomalies and other conditions (benign extra-axial subarachnoid space enlargement in infancy, which can give rise to abnormal pericerebral fluid collections in either the subdural or subarachnoid space and stretching of the fragile cortical bridging veins giving rise to the potential for spontaneous rupture). Subdural hemorrhage may occur at any age, however, they are especially prevalent in the two extremes of life, infancy and the elderly. In both infancy and the elderly there is a large subarachnoid space. In infancy the enlarged subarachnoid space is developmental, whereas in the elderly it is due to atrophy of the brain. In both cases the bridging veins must traverse a widen space, thus making them very vulnerable to shearing stresses.